NEPA Threshold Determinations; A Framework of Analysis

The authors suggest that traditional concepts of judidical review are ineffective in promoting the intent of the National Environmental Policy Act to inject environmental considerations into all federal agency decisionmaking. They propose the adoption of a framework of analysis to serve as a guideline for agencies in making the threshold determination of whether to file an environmental impact statement

Emotional dysfunction in schizophrenia spectrum psychosis: the role of illness perceptions

Background. Assessing illness perceptions has been useful in a range of medical disorders. This study of people with a recent relapse of their psychosis examines the relationship between illness perception, their emotional responses and their attitudes to medication.Method. One hundred patients diagnosed with a non-affective psychotic disorder were assessed within 3 months of relapse. Measures included insight, self-reported. illness perceptions, medication adherence, depression, self-esteem and anxiety.Results. Illness perceptions about psychosis explained 46, 36 and 34% of the variance in depression, anxiety and self-esteem respectively. However, self-reported medication adherence was more strongly associated with a measure of insight.Conclusions. Negative illness perceptions in psychosis are clearly related to depression, anxiety and self-esteem. These in turn have been linked to symptom maintenance and recurrence. Clinical interventions that foster appraisals of recovery rather than of chronicity and severity may therefore improve emotional well-being in people with psychosis. It might be better to address adherence to medication through direct attempts at helping them understand their need for treatment

A pilot case series of a brief acceptance and commitment therapy (ACT)-based guided self-help intervention for improving quality of life and mood in muscle disorders

This study aimed to demonstrate proof of concept and acceptability of a brief acceptance and commitment therapy (ACT)-based guided self-help intervention for improving quality of life (QoL) and mood for people with muscle disorders (MD). A case-series with an AB design was used to assess changes in primary (QoL) and secondary (depression and anxiety) outcome variables across the period of study. Change in the psychological process targeted by ACT – psychological flexibility – was also investigated, to allow insight into possible treatment mechanisms. Post-intervention, participants also completed a brief free-text evaluation. Relative to pre-intervention scores, four (of seven) participants showed varying degrees of improvement in all primary and secondary outcome variables and were thus considered responders. However, consistent concomitant improvements in psychological flexibility were not apparent. Participants reported a mostly positive experience of the intervention; all appeared to complete the intervention, and no adverse events were reported. Nonetheless, there was evidence that those with compromised concentration or who report good initial QoL and low levels of distress may derive less benefit. Although several methodological weaknesses limit the strength of our conclusions, this ACT-based guided self-help intervention shows encouraging utility for improving QoL and mood in MD

Chest computed tomography findings in HIV-infected individuals in the era of antiretroviral therapy

Background: Chest radiographic abnormalities were common in HIV-infected individuals in the pre-combination antiretroviral therapy era, but findings may differ now due to a changing spectrum of pulmonary complications. Copyright

A Physical Model to Estimate Snowfall over Land using AMSU-B Observations

In this study, we present an improved physical model to retrieve snowfall rate over land using brightness temperature observations from the National Oceanic and Atmospheric Administration's (NOAA) Advanced Microwave Sounder Unit-B (AMSU-B) at 89 GHz, 150 GHz, 183.3 +/- 1 GHz, 183.3 +/- 3 GHz, and 183.3 +/- 7 GHz. The retrieval model is applied to the New England blizzard of March 5, 2001 which deposited about 75 cm of snow over much of Vermont, New Hampshire, and northern New York. In this improved physical model, prior retrieval assumptions about snowflake shape, particle size distributions, environmental conditions, and optimization methodology have been updated. Here, single scattering parameters for snow particles are calculated with the Discrete-Dipole Approximation (DDA) method instead of assuming spherical shapes. Five different snow particle models (hexagonal columns, hexagonal plates, and three different kinds of aggregates) are considered. Snow particle size distributions are assumed to vary with air temperature and to follow aircraft measurements described by previous studies. Brightness temperatures at AMSU-B frequencies for the New England blizzard are calculated using these DDA calculated single scattering parameters and particle size distributions. The vertical profiles of pressure, temperature, relative humidity and hydrometeors are provided by MM5 model simulations. These profiles are treated as the a priori data base in the Bayesian retrieval algorithm. In algorithm applications to the blizzard data, calculated brightness temperatures associated with selected database profiles agree with AMSU-B observations to within about +/- 5 K at all five frequencies. Retrieved snowfall rates compare favorably with the near-concurrent National Weather Service (NWS) radar reflectivity measurements. The relationships between the NWS radar measured reflectivities Z(sub e) and retrieved snowfall rate R for a given snow particle model are derived by a histogram matching technique. All of these Z(sub e)-R relationships fall in the range of previously established Z(sub e)-R relationships for snowfall. This suggests that the current physical model developed in this study can reliably estimate the snowfall rate over land using the AMSU-B measured brightness temperatures

Multiple scattering of laser beams in dense hydrosols

The multiple scattering of laser beams is usually described within the framework of small-angle scattering theory. The validity of this approximation as well as improvements due to the incorporation of diffusion theory in the calculations were studied

Outlining an Acceptance and Commitment Therapy approach to treatment non-adherence

Non-adherence to effective treatments - inclusive of medications, physiotherapy, and psychological interventions – is a significant problem in healthcare delivery. The World Health Organisation reported an non-adherence rate of 30-50% in people taking medication for long-term conditions (Sabaté, 2003), which leads to significant adverse clinical, social and financial impacts (Khan & Socha-Dietrich , 2018). This problem is not restricted to medications. For example, uptake of pulmonary rehabilitation groups for COPD (Garrod, Marshall, Barley, & Jones, 2006) and psychological therapy groups for mental health conditions are often sub-optimal (Brebach, Sharpe, Costa, Rhodes, & Butow, 2016; Byrne et al., 2019; Michelson & Sclare, 2009). Despite extensive research on the causes of non-adherence (Kardas, Lewek, & Matyjaszczyk, 2013) and the evaluation of interventions (Conn, Ruppar, Enriquez, & Cooper, 2016), the challenge of non-adherence is still very much present

Providing psychological support to people in intensive care: development and feasibility study of a nurse-led intervention to prevent acute stress and long-term morbidity

OBJECTIVES: Adverse psychological outcomes, following stressful experiences in critical care, affect up to 50% of patients. We aimed to develop and test the feasibility of a psychological intervention to reduce acute stress and prevent future morbidity. DESIGN: A mixed-methods intervention development study, using two stages of the UK Medical Research Council framework for developing and testing complex interventions. Stage one (development) involved identifying an evidence base for the intervention, developing a theoretical understanding of likely processes of change and modelling change processes and outcomes. Stage two comprised two linked feasibility studies. SETTING: Four UK general adult critical care units. PARTICIPANTS: Stage one: former and current patients, and psychology, nursing and education experts. Stage two: current patients and staff. OUTCOMES: Feasibility and acceptability to staff and patients of content and delivery of a psychological intervention, assessed using quantitative and qualitative data. Estimated recruitment and retention rates for a clinical trial. RESULTS: Building on prior work, we standardised the preventative, nurse-led Provision Of Psychological support to People in Intensive Care (POPPI) intervention. We devised courses and materials to train staff to create a therapeutic environment, to identify patients with acute stress and to deliver three stress support sessions and a relaxation and recovery programme to them. 127 awake, orientated patients took part in an intervention feasibility study in two hospitals. Patient and staff data indicated the complex intervention was feasible and acceptable. Feedback was used to refine the intervention. 86 different patients entered a separate trial procedures study in two other hospitals, of which 66 (80% of surviving patients) completed questionnaires on post-traumatic stress, depression and health 5 months after recruitment. CONCLUSION: The 'POPPI' psychological intervention to reduce acute patient stress in critical care and prevent future psychological morbidity was feasible and acceptable. It was refined for evaluation in a cluster randomised clinical trial. TRIAL REGISTRATION NUMBER: ISRCTN61088114; Results